Question Easy:
A 28-year-old woman, who is 8 weeks pregnant, presents to her GP with complaints of nausea and occasional vomiting 🤢. Which of the following is the first-line pharmacological treatment for nausea and vomiting in pregnancy according to NICE guidelines?
A) Dexamethasone
B) Ondansetron
C) Promethazine
D) Metoclopramide
E) Pyridoxine
Question Medium:
A 35-year-old woman presents to the gynaecology clinic with dysmenorrhea and menorrhagia. An ultrasound shows a 3 cm intramural fibroid. What is the first-line management option to control her symptoms according to NICE guidelines?
A) Levonorgestrel-releasing intrauterine system (LNG-IUS)
B) Gonadotropin-releasing hormone (GnRH) agonists
C) Hysterectomy
D) Endometrial ablation
E) Non-steroidal anti-inflammatory drugs (NSAIDs)
Question Hard:
A 42-year-old woman has been diagnosed with gestational trophoblastic disease (GTD) following a recent molar pregnancy evacuation. Her serum hCG levels remain elevated beyond the normal range for six months post-evacuation. What is the recommended medical management for persistent GTD with raised hCG levels according to NICE guidance?
A) Methotrexate
B) Doxorubicin
C) Carboplatin
D) Paclitaxel
E) Cyclophosphamide
Explanations & Answers:
Question Easy Answer: C) Promethazine
Question Easy Explanation: According to NICE guidelines, antihistamines such as promethazine are recommended as the first-line treatment for nausea and vomiting in pregnancy. They are considered safe and effective for use in pregnant women, providing relief from symptoms with minimal risk to the mother and fetus.
Question Medium Answer: A) Levonorgestrel-releasing intrauterine system (LNG-IUS)
Question Medium Explanation: NICE guidelines recommend the LNG-IUS as the first-line management option for heavy menstrual bleeding when a woman also requires contraception. It is effective in reducing menstrual blood loss and can provide symptom relief for women with fibroids, especially when their size and location do not significantly distort the uterine cavity.
Question Hard Answer: A) Methotrexate
Question Hard Explanation: Methotrexate is the first-line treatment for persistent gestational trophoblastic disease (GTD) when serum hCG levels remain elevated following evacuation of a molar pregnancy. NICE guidelines recommend this chemotherapeutic agent due to its effectiveness in achieving remission by targeting rapidly dividing cells, helping to lower hCG levels to normal.
Medical fact of the day: Polyhydramnios, an excessive accumulation of amniotic fluid, can be associated with maternal conditions such as diabetes mellitus. Managing maternal glycemic levels in diabetic pregnancies is crucial to prevent this and other complications.
Quote of the day: “In the tapestry of medicine, every thread of care and compassion weaves a masterpiece of hope.”